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. Subjects with the disease of interest (case group) are comapred with an otherwise
similar group that is disease free (control group).
. It is retrospective study aiming at determining the association between risk
factors and disease occurance.
. The main measure of association is exposure Odds ratio can be calculated in the
case control study but incidence of the disease can't.
. One of the drawbacks of case control study is that the risk can not be drived
directly from it's results.
. It is more cheap and easy than cohort study.
.N.B.:
- Incidence measures ( e.g. relative risk or relative rate) can't be directly measured
in case-control study,
- Because the people being studied are those who have already developed the
disease.
- Relative risk and relative rate are calculated in cohort studies, where people are
followed over time for the occurance of the disease.
- prevalence odds ratio is calculated in cross-sectional studies to compare the
prevalence of the disease in different populations.
. (one with and one without agiven risk) allows for calculation of a relative risk.
. It is stronger than case-control study and cross sectional study.
. A CASE SERIES:
. A study involving only patients already diagnosed with the condition of interest.
. It is helpful in determining the natural history of uncommon conditions.
. But provids no information about the disease incidence.
. CLINICAL TRIALS:
. Compare the therapeutic benefit of different interventions in patient already
diagnosed with a particular disease.
. Usually subjects are randomly arranged into exposed (treatment group) & placebo
and then followed to detect the development of the outcome of interest.
. Can't be used to determine disease incidence.
. CLUSTER ANALYSIS:
. Is the grouping of differeny data point into similar categories.
. Usually involves randomization at the level of groups rather than at the level of
individuals.
. EFFECT MODIFICATION:
. Occurs when the effect a main exposure on an outcome is modified by another
variable.
. It is not a bias.
. It is a natural phenomenon that shoud be described not corrected as it is not a
bias or confoundation.
. Example: the effect of oral contraceptives on breast cancer is modified by he
family history.
. i.e. women with +ve family history have an increased risk, while women without
+ve family history don't have an increased risk.
. Other examples: studying the effect of estrogen on the risk of venous thrombosis
(modified by smoking).
. Also studying of the risk of lung cancer in people exposed to asbestos (greatly
depends on / modified by smoking).
. For exampl:
. the effect of a new estrogen receptors agonist drug on the incidence of DVT is
modified by smoking status:
. Smokers taking the drug have an increased risk of developing DVT, while
nonsmokers taking the drug don't.
. It may be confused with confounding, both can be diffrentiated by dividing the
whole cohort into subgroups (stratified analysis).
. Imagin that smoking is a confounding that, by itself is associated with a higher
risk of DVT, so if more smokers are taking the drug,
it might appear that the drug causes DVT, but when stratified analysis is
performed by analyzing smokers and nonsmokers separately,
it will appear that the drug is no longer associated with DVT.
. LATENT PERIOD:
. Is a time period required for an exposure to start the effect i.e the time require
from getting exposed to outcome.
. In infectious diseases it is relatively short, while in chronic diseases (e.g. cancer or
CAD),
it may be very long and extended period of exposure may be required to affect
the outcome.
. Latent period also can be applied to the exposure to risk modifier, as it may need
to be continous over a certain period of time before influencing the outcome.
. Latent period is a natural phenomenon not a bias.
. One weakness of the RR is that it gives no clue whether such finding can be
explained by chance alone.
. The confidence interval and the
study.
- The "p" value is used to strengthen the results of the study, it is defined as the
propability of obtaining the result by chance alone.
- e.g. "P" value is 0.01 means that (the probability of obtaining the result by
chance alone is 1%).
- Ther commonly accepted upper limit (cut-off point) of the "P" value for the study,
to be considered statisically significant is 0.05 (i.e. less than 5%).
- The "P" value deals with random variability, not bias.
- If the "P" value less than 0.05 (i.e the study is statistically significant), the 95%
confidence interval doesn't contain 1.0 (the null value for RR).
- A relative risk of 0.71 shows that the drug decreased the risk of mortality by 29%
(the null value for RR is 1).
e.g.: Acase of RR 1.6 (greater than 1) & the confidence interval 1.02-2.15 (doesn't
contain the null value 1),
so for the study to be statistically significant the "P" value must be less than
0.05.
N.B: Verrrrrry important to know how to calculate relative risk fron the 22 table:
.N.B.:
- The power of a study is the ability to detect a difference between two groups
(treated versus non treated, exposed versus non exposed).
- Increasing the sample size --> increases the power of the studyand consequently
makes
the confidence interval of the point of estimate (e.g. relative risk) tighter.
- If the sample size is small --> low power of study to detect the difference between
exposed and non exposed subjects &
this makes the confidence interval of the study wide (e.g. 0.8-3.1) and makes the
study statistically insignificant.
- And if we increase the sample size --> the confidence interval will be tighter and
the study will be statistically significant.
- Relative risk reduction (RRR)= ARR(control group) - ARR (treatment group)/ ARR
(control group).
. For example: drug X (deaths=60 & living=20) placebo drug (deaths=38 &
living=38).
. Adverse event rate in treatment group = 60/80= 0.75.
. Adverse event rate in placebo group = 38/76= 0.50.
. Attributable risk = 0.75 - 0.50 = 0.25.
. NNH 1/0.25 = 4.
. SELECTION BIAS:
. Results from the manner in which the subjects are selected for the study, from the
selective losses from the follow-up.
. BERKSONS BIAS:
. It is a selection bias that can be created by selecting a hospitalized patients as the
cotrol group.
. INFORMATION BIAS:
. Occurs due to imperfect assessment of the association between the exposure and
outcome.
. As a result of erorrs in the measurements of exposure and outcome status.
. It can be minimized by using standarized techniques for surveillance and
measurement of outcomes
as well as trained observers to measure the exposure and outcome.
. MEASUREMENT BIAS:
. LEAD-TIME BIAS:
. Lead-time bias should be considered while evaluating any screening test.
. It happens when two interventions are compared to diagnose a disease,
and one of them diagnose the disease earlier than the other without an effect on
the outcome (survival).
. What actually happens is that detection of the disease was made at an earlier
point of time,
. But the disease course itself or the prognosis did not change.
. So the screened patients appeared to live longer from the time of diagnosis till the
time of death.
. Think of LEAD BIAS when you see " a new screening test" for
poor prognosis diseases like lung cancer or pancreatic cancer.
. RECALL BIAS:
. Detection Bias:
. Refers to the fact that a risk factor itself may lead to extensive diagnostic
investigations and increase the probability that a disease is identified.
. For example: patients who smoke may undergo increased imaging surveillance
due to their smoking status, which would detect more cases of cancer in general.
. RESPONDENT BIAS:
. Occurs when the outcome of the test is obtained by the patient's response not by
objective diagnostic methods (e.g. migrane headache).
. SUSCEPTABILITY BIAS:
. Is a type of selection bias where a treatment regimen is selected for a patient
based on the severity of their condition,
. Allocation bias:
. It may result fro the way that treatment and control groups are assembled.
. It may occur if the subjects are assigned to the study groups of a clinical trial in a
non random fashion.
. For example in a study group comparing oral NSAIDs and intra-articular
corticosteroid injections for the treatment of osteoarthritis,
obese patients may be pereferentially assigned to the corticosteroid group (affect
the outcome).
. Beta erorr:
. Reffer to a conclusion that there is no difference between the groups studied when
a difference truely existing.
. It is a random erorr not a systemic erorr (i.e bias).
. CONFOUNDING:
. Occurs when at least part of the exposure-disease relation ship can be explained
by another variable (confounding).
. Due to presence of one or more variables associated independently with both the
exposure and the outcome.
. For example: cigarette smoking can be a aconfounding factor in studying the
association between maternal alcohol drinking and low birth weight babies.
. As cigarette smoking is independently associated with alcohol consumption and
low borth weight babies.
. Hawthorne effect:
. Pygalion EFFECT:
. It describes researcher's beleifs in the efficacy of treatment that can potentially
affect the outcome.
. HAZARD RATIO:
. It is the ratio of the chance of an event occuring in the treatment arm (drug or
group of interest),
. compared to the chance of that event occuring in the control arm (the other drug
or group) during a set period of time.
. Hazard ratio = event occuring in the test group / event occuring in the control
group.
. So; the lower the hazaed ratio, the less likely the event will occur in the treatment
arm.
. The higher the ratio, the more likely the event will occur in the treatment arm.
. A ratio close to 1 indicates no significant difference between the 2 groups,
. Example: Hazard ratio of 2 drugs A & B in bleeding complications:
. Hazard ratio for major bleeding = 0.93 i.e. close to 1 means that both groups are
similar to each others in this event.
. Hazard ratio for intracranial bleeding = 0.41 (indicates the lower chance of drug
"A" to cause intracranial bleeding than drug "B").
. Hazard ratio for GIT bleeding = 1.50 (indicates that drug "A" has a higher chance
to cause GIT than drug "B").
. Hazard ratio for life threating bleeding = 0.80 (indicates the lower chance of drug
"A" to cause intracranial bleeding than drug "B").
. Hazard ratio for total bleeding = 0.91 (indicates the slight lower chance of drug
"A" to cause intracranial bleeding than drug "B").
. In case number (11 ofline) you should focus on the baseline value in the case in
take the corresponding hazard ratio in the study then
. decide, which one of them has the greater hazard of hyperkalemia (N.B. Ca
channel blockersaffects GFR).
. You should learn case 19 in offline 2013. :)
. SUCCESSFUL RANDOMIZATION:
. In any randomized clinical study, the goal of successful randamization is:
1- to eliminate bias in treatment assignments.
2- Blind the inestigators from the identity of the patients who receive the
treatment arm.
3- Minimize the confounding variables.
. Ideal randomization allows for adequate statistical power and should include:
1- equal patient group sizes.
2- Low selection bias.
3- Low propability of confounding variables.
. A listing of the base line characteristics of the patients in each armwould
demonstrate,
if the two arms had patients with similar characteristics and would insure the
proper randomization occured in the study
. META-ANALYSIS:
. Is an epidemiologic meathod for pooling of the data from several studies to do an
analysis having a relatively big statistical power.
. For example: individual studies assessing the effects of aspirin on certain
cardiovascular events may be inconclusive,
. However analysis of data compiled from multiple clinical trials may reveale a
significant benefite.
. For example:
. A study uses 3 different interventions beta blocker (metoprolol), calc. channel
blocker (amlodipine) or ACEIs (ramipril)
with to two different variable bl pr. endpoints (102-107 mmHg or < 92 mmHg).
# Patient Randomization:
1) ACEIs:
- higher bp goal
- Lower bp goal.
2) Beta blocker:
- higher bp goal
- Lower bp goal.
3) Ca channel blocker:
- higher bp goal
- Lower bp goal.
- The long slop of the curve "the tail" extends in the positive direction.
- The mean is the most shifted to the positive direction followed be the median
then the mode.
- So the mean is greater than the median.
- In strongly skewed distributions, the median is a better measure for centeral
tendency than the mean.
2) Negatively sekewed curve:
- Larger numbers predominate in the dataset.
- The long slop of the curve "the tail" extends in the negative direction.
- The mean is the most shifted to the negative direction followed by the median
then the mode.
- So the mode > the median > the mean (i.e the mean is the smallest).
- In strongly skewed distributions, the median is a better measure for centeral
tendency than the mean.
. SENSITIVITY:
. Sensitivity --> the proportion of true +ve cases among all diseased cases
(Sensitivity = true +ve by the test/all patients that are actually diseased).
. Indicates the ability of a test to detect those patient with disease.
. A higher sensitivity --> the higher the test detect patient with the disease -->
decrease false negatives.
. Screening tests (especially for diseases with severe sequally) should have a high
sensitivity.
. SPECIFICITY:
. Specificity --> the proportion of true -ve cases among all non diseased cases
(Specificity = true -ve by the test/all patients that are actully free).
. Is a measure of the true negative rate and indicates how will a test can rule out a
given condition (exclude those without the disease).
. The higher the specificity the more likely that most healthy patients will have a
-ve test results.
. The higher the specificity --> the less likely the false +ves.
. They are fixed values that are not vary with the pre-test probability of a disease or
with th prevalence of the disease.
. The ideal diagnostic test should have high sensitivity and specificity.
N.B.:
- Raising the cutoff point of a diagnostic test --> decrease it's sensitivity but
increase it's specificity.
- Lowering the cutoff point of a diagnostic test --> increase it's sensitivity but
decrease it's specificity.
. Increasing the sample size will decrease the "P" value of the odd's ratio and make
the confidence interval tighter.
.N.B:
- Attributable risk percent (ARP): represents the excess risk in a population that can
be attributed to the exposure to a particular risk factor.
. It can be calculated be subtracting the risk in the unexposed population (basline
risk) from the risk from the exposed population, and dividing the results by the risk
in the exposed population.
. ARP = (Risk in exposed - Risk in nonexposed)/Risk in exposed.
or
. ARP can be calculated from the relative risk as follow:
. ARP = (RR-1)/RR
. Pre and post-test Probabilities (+ve perdictive value (PPV) & -ve
predictive value:
. NPV will vary with the pre-test probability of a disease (important) i.e,
. A patient with high probability of having a disease will have a low NPV.
. And a patient with a low probability of having a disease will have a high NPV.
. If the NPV is 96 % this means that if the test result is -ve, the chances of the
patient to not have the disease is high (96%).
. And the chances of the patient to have the disease is low (100 - 96 = 4%).
Example:
1- BREAST CANCER & FNA test results:
. a patient of a high pre-test probability for having the disease (1st degree relative
having breast cancer or age > 40 ys), has a low NPV.
. a patient of a low pre-test probability for having breast cancer (less than 40 ys
old), has a high NPV.
NOTE:
. The prevalence of the disease is directly related to the pre-test probability of
having the disease (PPV) & inversely related to
the pre-test probability of not having the disease (NPV), so increased prevalence
--> low NPV but high PPV and vice versa.
. Sensitivity and specificity are not affected by the prevalence of the disease and so
the likehood ratio positive i.e sensitivity (1-specificity),
N.B.:
. If the test result is -ve , the probability of the patient to have the disease = 1 NPV.
. Cases and diagnostic tests tha are high yield USMLE questions in probabilities:
- coronary artery disease and ECG stress test.
- Pulmonary embolism and ventilation-perfusion scanning.
- Prostate cancer and serum PSA level.
N.B.: Also sensitivity and specificity of a test compare its results to the results
obtained by the gold standard test
. RELIABILITY:
. Test-retest reliability.
. A reliable test is reproducible; gives similar or very close results on repeat
measurements.
. Reliability is quantified in terms of Coefficient of variation (CV).
. COefficient of variation; is the standar deviation of the set of repeated
measurements divided by their mean & expressed as a percentage.
. ++ Sensitivity --> ++ true +ve & -- false -ve (diagnosed as normal but he is
diseased).
. ++ Sensitivity --> allaw not to miss any diseased patient (not to miss any true
+ve).
. ++ Specificity --> ++ true -ve & -- false +ve (diagnosed as diseased but he is
normal).
. ROC --> Aiming at decrease false -ve and false +ve results (i.e increase sensitivity
and specificity).
.N.B.:
- In ROC curve :
false positive.
while
(1-specificity) =
. Positive predictive value (ppv) --> is the probability of having the disease if the
test results are +ve.
. PPV = TP/(TP + FP).
. Negative predictive value (NPV) --> is the probability of not having the disease if
the test result is -ve.
. ROC curve has 2 lines; vertical line (Y) for sensitivity and horizontal line (X) for
specificity
. Large Y values --> Indicates High sensitivity.
. Small X values --> Indicates High specificity.
. Low cutoff --> Increase sensitivity (better ability to identify patients with the
disease i.e increase true positive),
Although this causes decrease specificity (the test falsely identifies more subjects
as diseased also they are not) and vice versa.
. High cutoff --> Decrease sensitivity and Increase specificity.
. Low cutoff --> High Sensitivity --> higher negative predictive value (NPV) -->
decrease false -ve results (Ruling out probability).
. High cutoff --> Higher Specificity --> higher positive predictive value (PPV) -->
decrease false +ve results (Ruling in probability).
. A shift of the ROC curve upwards for a given cutoff indicates increased sensitivity
and vice versa.
. A shift of the curve to the right for a given cutoff (higher value)indicates
decreased sensitivity and vice versa.
. Both sensitivity and specificity depend on the cutoff value of a given test for
example:
. Raising the cutoff value makes it more difficult to diagnose the condition i.e
it makes it harder to obtain +ve results and easier to obtain -ve results --> this will
increase specificity but decrease sensitivity.
. Lowering the cutoff value makes it easier to obtain +ve results and harder to
obtain -ve results,
i.e increase sensitivity and decrease specificity.
. Increase sensitivity --> increase -ve predictive value (NPV) due to (decrease false
-ve results).
. Increase specificity --> increase +ve predictive value (PPV) due to (decrease false
+ve results).
. PERCISION:
. Is the proportion of the true +ve results out of the total number of the true results
of the test (-ve results are not taken into account).
. ACCURACY:
. Is the proportion of the true results (true +ve and true -ve) out of all results that
are predicted by the test.
. The closer the ploted curve approaches the left and top borders of the ROC curve,
the more accurate the test.
. Accuracy can also be measured by the total area under the plotted curve on ROC
curve.
. Increase of the total area under the curve --> increases the accuracy of the test.
.N.B:
. Both accuracy and percision depend upon sensitivity and specificity of the test as
well as the prevalence of the condition in the population tested.
. Validity and accuracy are measures of systematic errors (bias).
. Accuracy is reduced if the sample doesn't reflect the true value of the parameter
measured.
. Increasing the sample size --> increases the percision of the study, but doesn't
affect the accuracy.
. Risk:
. It measures the incidence of the disease.
. It is calculated by divide the number of diseased subjects by the number of people
at risk or of interest.
. No of diseased/people at risk.
. EXAMPLE: 5,6,7,5,10,3
.EX2: 5,6,8,9,11.
. Median = (5+1)/2 = 3. so Median is the 3rd observation --> median = 8.
. EX3: 5,6,8,9
. Median = 4/2 = 2. so median is the 2nd obsrvation.
. Median will be the mean of observations 2&3 --> (6+8)/2 = 7.
.N.B.:
. Range: is a measure of variation (dispersion).
. Range: is the difference between the largest and the smallest values
. Range = lagest value - smallest value
e.g.Range = 9-5 = 4.
.N.B.:
. Average: it is the summation of the total number of observations divided by the
sample size.
. e.g. in random sample of children the number of episods of UTIs are as follow (50
child (0), 30 child (1), 10 child (2), 10 child (3)).
. The average number of UTIs episods per year in a child is;
- the number of UTIs episods per years is: (500) + (301) + (102) + (103) =
80 UTIs episod per year.
- The average number of UTIs episods per year in a child = 80/100 = 0.8 (between
0 and 1)
- i.e the child experiences less than one attack of UTIs per year.
. SCATTER PLOTS:
. They are useful for crude analysis of data.
. They can demonstrate the type of association (linear or non linear).
. If a linear association is oresent, the correlation coefficient can be calculated.
. The association is positive (if the outcome increases with the increase in the
exposure) -> +ve correlation coefficient while
the association is negative (if outcome decreases with the increase in exposure)
-> -ve correlation coefficient.
. the correlation coefficient in an almost perfect linear association is close to 1.
. Crude analysis of association using the scatter plots doesn't account for possible
confounders.
.N.B:
1- It is very important to consider the natural history of a disease when evaluating
the effectiveness of a druge in a trial,
e.g. common cold --> natural esolution within one week should be taken in
consideration while evaluating,
an anti-viral drug used in treatment of common cold.
2- It is difficult to comment on a druge effectiveness, unless a comparison is made
with the control group and
statisical significance is made to know the power of the study.
. NULL HYPOTHESIS:
. Is always the statement of NO relationship between the exposure and the
outcome.
. To state the null hypothesis correctly you should recognize the study design first.
. In cross-sectional study: the 2 variables (CRP & cancer colon) are studied at the
same point of time so,
the temporal relationship between the 2 variable can't be evaluated.
. So you can't measure the relationship between the 2 variables --> Null hypothesis
is better considered.
. ALTERNATIVE HTPOTHESIS:
. It Opposes the Null hypothesis.
. It States that there is a relationship between the exposure and the outcome.
. It is better for studies in which a relationship between the 2 variables is existing to
consider the Alternative hypothesis.
2- How to caculate:
. Sensitivity = true +ve by the test / (true +ve + false -ve) all patients that are
actually diseased.
. True positive = sensitivity (true +ve + false -ve) i.e(N. of patients actually with
the disease).
. True negative = (1- sensitivity) (true +ve + false -ve) i.e. (N. of patiets actually
with the disease).
. Specificity = true -ve by the test/ (true -ve + false +ve) all patients that are
actully free.
. True negative = specificty (true -ve + false +ve) i.e all patients that are actully
free.
. Type II erorr:
. Occurs when the researchers fail to reject the null hypothesis when the null
hypothesis is really false,
(they say there is no difference when actually there is (one) difference).
. It causes the investigators to miss true relationships.
. An example: a study finding that doesn't affect platelet function when, in fact it
does.
. Beta (B): is the probability of committing a type II erorr.
. If (B) is set at 0.2 (20%) i.e there will be a 20% chance to accept the null
hypothesis when it is false -->
the power (1-B) will be 0.8 (8o%) i.e there will be a 80% chance of rejecting the
null hypothesis when it is truly false.
. Type I erorr:
. Occurs when the researchers reject the null hypothesis when the null hypothesis
is really true,
(they say there is difference when actually there is no difference)..
. i.e the study finds a statistically significant difference between 2 groups when it is
actually not existing.
. An example: If a study concluded that hard candy improves heart failure mortality,
when it doesn't.
. Alpha (a): is the maximum probability of making type I erorr a researcher is willing
to accept.
. It corresponds with the 'P" value or the probability of making a type I erorr.
. The (a) is typically set at P= 0.05, meaning that the researchers accept a 5%
possibility that the difference preceived as true is actually due to chance.
N.B
in
a,b,c,d table:
N.B:
- There are 4 basic payment methods that exist between health insurance and
physicians:
1) Capitation:
. Physicians are paid fixed amount of money per enrollee, not per service (i.e paid
by capitation).
. So they have incentives to contain (decrease) costs per enrollee due to the fixed
budget allocated for them.
. If many enrollees seek care or there are enrollees need extensive care, physicians
costs may be greater than their payments.
. So physicians are motivated to provied more preventive care to catch illness early
so patients stay healthier and need fewer tests and procedures as they age.
4) Salary:
. Physicians are paid a fixed amount and their pay is not tied to number of enrollees
or services rendered (provided).
. Unless their contracts includ withholds or bonuses, salaried physicians face no
financial risk.
. So they have no financial incentive to change their treatment patterns, either in
service provided or number of follow up visits.
N.B.:
- A state with a population of 4,000,000 contains 20,000 people who have disease
A, a fatal neurodegenerative condition. there are 7,000 new cases of the disease,
a year and 1000 deaths attributable to disease A. there are 40,000 deaths per
year from all causes, what is the ....??
1- Incidence of the disease: is the number of new cases of a disease per year
divided by population at risk.
2- The disease specific mortality: is the number of deaths attributable to the disease
per year divided by the total population.
The disease specific mortality = 1000/4,000,000.
3- The rate of increase of a disease: is the number of new cases per year minus the
number of deaths (or cures) per year divided by the total popeolation.
The rate of increase of a disease = (7000-1000)/4,000,000.
4- The prevalence of a disease: is the number of persons with the disease divided
by the total population at a specfic point of time.
The prevalence of a disease = 20,000 / 4,000,000.
5- The mortality rate: is the number of deaths per year divided by the total
population.
The mortality rate = 40,000 / 4,000,000.
1- An increase in lung cancer incidence and mortality has been observed in women
over the last four decades due to increased cigarette smoking.
2- Breast cancer is the most common non skin cancer among women in USA, but
breast cancer mortality is comperatively low,
3- Mortality from breast cancer has stayed relatively stable overtime, where as
colon cancer mortality decreased some what over the last decades.
4- Stomach cancer is now uncommon, so it's incidence and mortality have been
drastically decreased in the last decades.
5- Mortality of ovarian cancer is stabe over time.
6- A part from skin cancer, the most common women cancer are ordered in
descending according to incidence: Breast cancer, Lung cancer then colon cancer.
7- In order of mortality: Lung cancer followed by Breast cancer then colon cancer.
N.B.:
- case-Fatality rate: is calculated by dividing the fatal cases by the total number of
people with the disease.
- Case-fatality = Number of fatal cases/total number of people with the disease.
N.B:
- If events are independent, the probability that all events will turn out the same
(e.g. -ve) is the product of the separate probabilities for each event.
- The probability of at least 1 event turnning out differently is given as: 1- (the
probability of all events being the same).
- For example:
A new seriological test for detecting prostate cancer is negative in 95% of patients
who dont have the disease, if the test is used on 8 blood samples
taken from patients with out prostate cancer, what is the probability of getting at
least 1 positive test.
- In this case a 0.95 (95%)probability of giving a true negative result and 0.05 (5%)
probability of giving false positive result.
8
- To calculate the chance of all 8 tests being negative: probability (all negative)=
(0.95).
- you have to to know that the total probability is always equal to 1.0 (100%).so
- The probabilty that at least 1 test turns out positive is: